Article

OBJECTIVE: To assess the validity of diagnostic clusters combining history
elements and physical examination tests to diagnose or exclude patellofemoral
pain (PFP). DESIGN: Prospective diagnostic study. SETTINGS: Orthopedic outpatient
clinics, family medicine clinics, and community-dwelling. PARTICIPANTS:
Consecutive patients (N=279) consulting one of the participating orthopedic
surgeons (n=3) or sport medicine physicians (n=2) for any knee complaint.
INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: History elements and
physical examination tests were obtained by a trained physiotherapist blinded to
the reference standard: a composite diagnosis including both physical examination
tests and imaging results interpretation performed by an expert physician.
Penalized logistic regression (least absolute shrinkage and selection operator)
was used to identify history elements and physical examination tests associated
with the diagnosis of PFP, and recursive partitioning was used to develop
diagnostic clusters. Diagnostic accuracy measures including sensitivity,
specificity, positive and negative predictive values, and positive and negative
likelihood ratios with associated 95% confidence intervals (CIs) were calculated.
RESULTS: Two hundred seventy-nine participants were evaluated, and 75 had a
diagnosis of PFP (26.9%). Different combinations of history elements and physical
examination tests including the age of participants, knee pain location,
difficulty descending stairs, patellar facet palpation, and passive knee
extension range of motion were associated with a diagnosis of PFP and used in
clusters to accurately discriminate between individuals with PFP and individuals
without PFP. Two diagnostic clusters developed to confirm the presence of PFP
yielded a positive likelihood ratio of 8.7 (95% CI, 5.2-14.6) and 3 clusters to
exclude PFP yielded a negative likelihood ratio of .12 (95% CI, .06-.27).
CONCLUSIONS: Diagnostic clusters combining common history elements and physical
examination tests that can accurately diagnose or exclude PFP compared to various
knee disorders were developed. External validation is required before clinical
use.
CI - Copyright (c) 2017 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS